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MRI Spinal Canal, Cervical with contrast

2020 CPT/HCPCS 72142
Negotiated Private Fee $720.00
Prossam $500.00
Champva $316.32
First Medical $625.00
First Medical Vital $225.75
Plan de Salud Menonita $700.00
Menonita Vital $267.85
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $725.00
Mapfre $650.00
Mcs Classicare $387.50
MCS Life $465.00
Medicare Ambulatory Payment classification (APC)
MMM $356.85
MMM Vital $234.37
Panamerican Life $725.00
PMC $356.85
Tricare $302.21
Triple S Salud $650.00
Triple S Vital $262.50
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $225.75
Negotiated Maximus Charge $725.00
Discounted Cash Price $576.00

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